Moral dilemmas, decisions and distress are the three “Ds” in nursing that require resilience and courage to overcome. It is normal to get distressed in life. Though it is something none of us wants and everyone tries to avoid.
Usually, the cause of physical and emotional pain can upset and disrupt our lives. Distress can develop due to various reasons, such as financial problems, work situations and family issues. Everyone has experienced distress at one time or another in their lives.
Distress is usually emotional and causes you to feel overwhelmed, nervous, anxious, and even afraid. Physical distress can cause GI upsets, headaches, respiratory problems, and more. If you are a practicing nurse, then the distress can have severe consequences if left unaddressed.
According to the nature of our work, we often find ourselves in situations that others may have never experienced. It can be caused by patient care problems, such as informed consent, end-of-life decisions, and advanced directives.
It can also develop as a result of staff or workplace issues caused by communication gaps, accidents, errors, and poor decisions.
All these issues are part and parcel of nursing and for most nurses can become a moral dilemma quickly. The decisions that some situations call for can enhance the distress level and often cause moral distress.
What is Moral Distress? How to deal with Moral Distress?
Moral distress has been a point of interest and research in the healthcare industry for over 30 years. Many professionals wonder if they are experiencing moral distress, what moral distress feels like and how it happens.
Researching moral distress is one thing, but dealing with it requires a deeper understanding of what moral distress is. Studies have shown a direct link between the dilemma and the decisions you deal with. The inner struggle between dilemma and decision can cause moral distress to develop.
According to Andrew Jameson, moral distress occurs when a nurse is aware of the right thing to do, but institutional restrictions make it prohibitive and impossible to pursue the morally right course of action. This usually happens when a nurse believes they know the right thing to do but feels helpless or afraid to do so.
As many patient care situations can be serious, some see moral distress to be an expected part of being a professional nurse that needs to be accepted.
In short, moral distress is caused when you can’t accept that you’re being asked to do something which you believe to be morally and ethically wrong, while the organization’s rules and regulations of the superiors do not believe so.
This is where moral courage is useful.
What Is Moral Courage?
Moral courage has the conviction and courage to stand up for what you believe in. It is not always easy to show moral courage, even if you are grown up. Most people believe they have strong moral courage even though they have not experienced moral distress. Enough moral courage enables you to challenge and speak up against unacceptable policies and practices, though it does not always happen.
Taking a stand against morally distressing situations is quite difficult but not impossible. Besides this, speaking up against an amoral or unethical order may only help a little though it may not relieve the moral distress you are experiencing. It takes practice to have moral courage and to display it when needed.
According to research by the American Nurses Association, even the most morally courageous staff may have fear of speaking up.
How Does Resilience Help Beat Moral Distress?
Resilience is commonly heard in discussions on moral distress. According to studies, moral resilience is the ability to handle diverse ethical situations without suffering the lasting effects of moral distress. This requires morally courageous action, needs support, and doing the right thing.
So, the question arises – How to effectively address moral distress as a nurse?
The American Nurses Association (ANA) has nine recommendations that show the ways you can work, develop and improve your moral courage and resilience. These are:
- Adopting ANA’s Healthy Nurse Healthy Nation strategies. This helps to support your overall well-being as a foundation for developing moral resilience.
- Reading, reviewing, and implementing the ANA Code of Ethics for Nurses, with interpretive statements to get the right knowledge to strengthen ethical competence.
- Seeking opportunities to learn to recognize, analyze and take ethically grounded action as a response to ethical complexity, conflict, or disagreement.
- Cultivating self-awareness to identify and respond to symptoms of moral distress and moral suffering in general.
- Pursuing educational opportunities that help to develop mindfulness, moral resilience, and ethical competence.
- Developing your personal plan to support overall well-being and ensure improved moral resilience.
- Becoming involved and initiating workplace efforts to remedy the root cause of moral distress or other types of moral suffering.
- Developing and practicing skills in mindfulness, communication, inter-professional collaboration and conflict transformation
- Recognizing and using personal resources within your organization and community (like peer-to-peer support, ethics committee, counseling, etc.) under employee assistance programs.
Moral distress is a common experience for practicing nurses, irrespective of their field of specialty. This problem can be remedied with moral courage and resilience.
You need to recognize the signs and causes of your moral distress, so you can find the courage and resilience to overcome it and not let it affect your responsibilities and professional performance in a healthcare setting.